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Mortality associated with early changes in ARDS severity in COVID-19 patients - Insights from the PRoVENT-COVID study.
Schuijt, Michiel T U; Martin-Loeches, Ignacio; Schultz, Marcus J; Paulus, Frederique; Neto, Ary Serpa.
  • Schuijt MTU; Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, the Netherlands. Electronic address: m.t.u.schuijt@amsterdamumc.nl.
  • Martin-Loeches I; Department of Clinical Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital & Trinity Centre for Health Sciences, Dublin, Ireland.
  • Schultz MJ; Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • Paulus F; Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, the Netherlands; ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands.
  • Neto AS; Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, the Netherlands; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.
J Crit Care ; 65: 237-245, 2021 10.
Article in English | MEDLINE | ID: covidwho-1300867
ABSTRACT

PURPOSE:

We investigated changes in ARDS severity and associations with outcome in COVID-19 ARDS patients.

METHODS:

We compared outcomes in patients with ARDS classified as 'mild', 'moderate' or 'severe' at calendar day 1, and after reclassification at calendar day 2. The primary endpoint was 28-day mortality. We also identified which ventilatory parameters had an association with presence of severe ARDS at day 2. We repeated the analysis for reclassification at calendar day 4.

RESULTS:

Of 895 patients, 8.5%, 60.1% and 31.4% had mild, moderate and severe ARDS at day 1. These proportions were 13.5%, 72.6% and 13.9% at day 2. 28-day mortality was 25.3%, 31.3% and 32.0% in patients with mild, moderate and severe ARDS at day 1 (p = 0.537), compared to 28.6%, 29.2% and 44.3% in patients reclassified at day 2 (p = 0.005). No ventilatory parameter had an independent association with presence of severe ARDS at day 2. Findings were not different reclassifying at day 4.

CONCLUSIONS:

In this cohort of COVID-19 patients, ARDS severity and mortality between severity classes changed substantially over the first 4 days of ventilation. These findings are important, as reclassification could help identify target patients that may benefit from alternative approaches.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: J Crit Care Journal subject: Critical Care Year: 2021 Document Type: Article